羥氯奎寧於全身性紅斑狼瘡的關鍵角色

The Key Role of Hydroxychloroquine in the Treatment of Systemic Lupus Erythematosus

在全身性紅斑狼瘡的傳統治療藥物當中，除了類固醇，最重要的藥物就當屬奎寧莫屬。奎寧之最初是一種抗瘧疾藥物，到了1950年代才被認可用於狼瘡治療。儘管機轉尚不明確，奎寧已被證實有廣泛且重要的臨床效果，包括減少疾病復發、減少併發症、保護器官功能及延長病人壽命等，至今仍難有藥物能取代奎寧的角色。然而，其應用也伴隨著劑量相關的風險，長期使用下難以忽視；尤其以視網膜病變的風險，隨著檢查技術進步，能夠在早期檢出更高比例的病人。臨床實務上，所有紅斑狼瘡病人都建議使用奎寧，劑量則須參考病人的病情，並在治療效益與風險之間取得平衡。醫師與病人的溝通和多專科醫師的合作，是確保療效與安全性的關鍵。

Among the traditional therapeutic agents for systemic lupus erythematosus (SLE), hydroxychloroquine stands out as the most important medication besides corticosteroids. Initially discovered as an anti-malarial drug, hydroxychloroquine was not approved for lupus treatment until the 1950s. Despite the unclear mechanism, hydroxychloroquine has been shown to have broad and significant clinical effects, including reducing risk of disease flare, reducing damage accrual, and prolonging patient survival. To date, the role of hydroxychloroquine in SLE still remained unique and cannot be replaced by any currently available treatment. On the other hand, longterm use of hydroxychloroquine is associated with retinal toxicity. The major risk factors are the daily dose and treatment duration. With the advanced techniques including optical coherence tomography visual field testing, higher proportion of patients with mild or no visual symptoms can be diagnosed. In clinical practice, all patients with lupus erythematosus are recommended to use hydroxychloroquine, and the dosage needs to refer to the patient's disease status and balance the therapeutic benefits and risks. Communication between doctors and patients and cooperation among multiple specialists are the key to ensuring efficacy and safety.